Practice Clinical update

Management of paediatric hernia

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4484 (Published 19 October 2017) Cite this as: BMJ 2017;359:j4484
  1. Kirk Bowling, ST8 in general surgery,1,
  2. Natasha Hart, ST in paediatrics,2,
  3. Phil Cox, general practitioner,3,
  4. Gandrapu Srinivas, consultant general paediatric surgeon4
  1. 1Derriford Hospital, Plymouth, UK
  2. 2Royal Devon and Exeter Hospital, Exeter, UK
  3. 3Riversdale Surgery, Bridgend, UK
  4. 4Torbay Hospital, Torquay, UK
  1. Correspondence to K Bowling kirk.bowling{at}nhs.net

What you need to know

  • Umbilical hernias rarely incarcerate, and most close spontaneously by the child’s fifth birthday. Reassure parents of children with asymptomatic umbilical hernias that complications are rare, and that most hernias close spontaneously by the child’s fourth year

  • Repair can be offered for epigastric hernias on a routine non-urgent basis, as this type of hernia will not resolve itself

  • Inguinal hernias have a substantial risk of complication. Refer for specialist assessment and surgical intervention

  • A unilateral tender, swollen, erythematous scrotum can be either a torted testis or an incarcerated hernia: both require urgent surgical referral

A hernia is the protrusion of an organ, such as the bowel, through the wall of the cavity in which it normally resides.1 Paediatric hernias are common developmental abnormalities which have different management from their adult equivalents. Conducting research in the management of paediatric hernias is challenging because of ethical considerations and variations in treatment practice. This article provides the generalist with essential information, enabling them to educate parents, alleviate anxiety, and where appropriate enable management of hernias in primary care. We discuss three types of common paediatric hernias.

Umbilical hernia

How common is it?

Umbilical hernia affects an estimated 10-30% of all white children at birth, reducing to 2-10% at one year.23 Rates in the African population have been estimated at 23-85%.456 The exact aetiology predisposing African populations at increased risk is unknown.47 Risk factors can be seen in table 1.

View this table:
Table 1

Risk factors for paediatric hernia

What is the anatomy?

The umbilical ring exists to allow passage of vessels through the abdominal wall muscles between mother and fetus. After birth and disintegration of the cord, the ring remains, with spontaneous closure typically by the child’s fifth year through growth of the abdominal muscles and fusion of peritoneal and fascial layers. A failure or delay in this …

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